Provider Demographics
NPI:1174062830
Name:RILEY, DAVID J (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:RILEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-9741
Mailing Address - Country:US
Mailing Address - Phone:406-443-3455
Mailing Address - Fax:406-443-5472
Practice Address - Street 1:2750 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-9741
Practice Address - Country:US
Practice Address - Phone:406-443-3455
Practice Address - Fax:406-443-5472
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist